Healthcare Provider Details

I. General information

NPI: 1114891363
Provider Name (Legal Business Name): ANAHI MOON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 N 59TH AVE
PHOENIX AZ
85033-4623
US

IV. Provider business mailing address

15619 W ROMA AVE
GOODYEAR AZ
85395-6358
US

V. Phone/Fax

Practice location:
  • Phone: 602-764-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number319867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: